November 30, 2020

The Niche

Knoepfler lab stem cell blog

Patient Q&A#2: Are autoimmune or stem cell transplant patients at higher risk from COVID-19?

COVID-19 stem cells autoimmune disease HSCT
Image from Florida Dept. of Public Health.

I’m continuing my stem cell patient Q&A series and today’s Q&A#2 post is focused on whether autoimmune patients generally or specifically those who have received chemo and hematopoietic stem cell transplants (HSCT) are at higher risk from COVID-19? Multiple patients have asked me this. It’s a great question and obviously urgent right now during the outbreak.

BTW, You can read patient Q&A#1 from this Q&A series on the potential for stem cell clinics to put patients at risk of graft-vs-host disease via stem cell injections.

Now back to today’s question.

While there is growing interest in the idea of clinical trials of certain kinds of stem cells to treat COVID-19 patients, mostly in China, what about the flip side?

For the many thousands of people who have already received chemo and HSCT for blood cancers and increasingly for autoimmune diseases in clinical trials, should they be extra cautious about COVID-19 and taking more steps to avoid infection with SARS-CoV-2?

What about autoimmune patients more generally including those taking immunosuppressive drugs– should they take extra precautions too?

The short answer is “Yes” to both.

The extra steps would involve things such as more substantial social distancing. However, there are many variables here and for some people social distancing may have more of a psychological toll. Talk to your physician before making any big changes of any kind.

According to this new piece by Multiple Sclerosis News Today, there could be reason to somewhat change the standard drug regimen for MS or other autoimmune diseases in some very specific cases during the novel coronavirus pandemic, but again you’ll want to first discuss that idea with your physician.

Note that the general CDC advice on COVID-19 can be found here.

While in theory those patients who have received a successful HSCT whether for cancer or autoimmune disease should have a substantially “rebooted” immune system, that may not always be the case. Also, the HSCT regimen for autoimmune diseases is still experimental so less known about the state of the immune systems of those who participated in the clinical trials so far, especially over years post-transplant. Patients with underlying medical conditions seem generally at much higher risk from COVID-19 too.

In addition, some organizations are proposing that patients now considering getting HSCT for autoimmune diseases delay that going forward for a while. For patients with serious blood cancers, such transplant delays may not be possible though. The MS Society of the UK had this to say on a helpful general information page for autoimmune patients in regard to COVID-19.

“Haematopoietic stem cell transplantation (HSCT)

HSCT is an intense chemotherapy treatment for MS. It aims to stop the damage MS causes by wiping out and then regrowing your immune system, using your stem cells. This treatment greatly hampers your immune system for a period of time. You and your neurologist or healthcare professional should consider delaying this treatment.”

Treatments for MS and other autoimmune diseases having nothing to do with stem cells also often involve immunosuppressive drugs as well, which likely leave patients more vulnerable to both getting infected with the coronavirus in the first place and having more severe symptoms. So whether you received HSCT or are taking other drugs for your autoimmune disease, now is the time if you haven’t already for detailed discussions and planning with your healthcare team related to social distancing and more.

Again, those patients who already received some form of chemo and successful HSCT have likely had their immune systems bounce back somewhat over time, but it’s just not possible to be sure for any given patient (without additional testing of your immune system) so taking extra caution makes the most sense to me.  Keep in mind too that the COVID-19 disease-causing virus SARS-CoV-2 is different from other viruses so I’d expect that it’s harder for doctors to predict for any given patient how they’ll do if infected, even if you have your blood count or other tests done, for example.

Disclaimer: I’m not a physician and this post is not intended as medical advice. Patients should talk to their own personal physicians about their risks, plans during the coronavirus outbreak, etc.

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